Burke J P, Haffner S M, Gaskill S P, Williams K L, Stern M P
Department of Medicine, University of Texas Health Science Center at San Antonio 78284-7873, USA.
Diabetes Care. 1998 Aug;21(8):1266-70. doi: 10.2337/diacare.21.8.1266.
To determine the incidence and the rate of reversion of type 2 diabetes to a nondiabetic status in the 7- to 8-year follow-up of the San Antonio Heart Study, and to determine the influence of the recent 1997 American Diabetes Association (ADA) criteria for diabetes on these rates. Individuals who revert have been problematic for those developing criteria for the diagnosis of type 2 diabetes. Few studies have addressed this issue using 1979 National Diabetes Data Group/1980 World Health Organization (WHO) criteria.
We studied 3,682 Mexican-American and non-Hispanic white men and nonpregnant women who completed both the baseline and follow-up examination of the San Antonio Heart Study. Incidence and reversion rates were calculated using both the 1980 WHO and the 1997 ADA criteria. Risk factors for reversion were identified, and the best fitting model using multiple logistic regression was determined using both the 1980 WHO and the 1997 ADA criteria.
Using the 1997 ADA criteria, the age-adjusted incidences of type 2 diabetes for Mexican-American men and women were 10.8 and 12.2%, respectively. For non-Hispanic white men and women, the age-adjusted incidence rates were 5.5 and 5.1%, respectively. Similar age-adjusted incidences were recorded using the 1980 WHO criteria. The reversion rate for individuals with type 2 diabetes was 11.5% using the 1980 WHO criteria and 12.5% using the 1997 ADA criteria. These rates were not significantly different. Numerous risk factors for reversion were identified. The best fitting model, after controlling for age, sex, and ethnicity, included baseline 2-h glucose level, baseline HDL cholesterol, and previous diagnosis of diabetes. The models were the same for both the 1980 WHO and the 1997 ADA criteria.
There was no significant difference in the incidence or the reversion rates for diabetic subjects using either 1980 WHO or 1997 ADA criteria. In addition, the risk factors for reversion were very similar using either set of criteria. The revision of the ADA criteria did not have a significant influence on reversion in this study.
在圣安东尼奥心脏研究7至8年的随访中，确定2型糖尿病转变为非糖尿病状态的发生率及逆转率，并确定1997年美国糖尿病协会（ADA）最新的糖尿病诊断标准对这些比率的影响。对于制定2型糖尿病诊断标准的人来说，病情逆转的个体一直是个难题。很少有研究使用1979年美国国家糖尿病数据组/1980年世界卫生组织（WHO）的标准来解决这个问题。
我们研究了3682名完成了圣安东尼奥心脏研究基线和随访检查的墨西哥裔美国人和非西班牙裔白人男性及非妊娠女性。使用1980年WHO标准和1997年ADA标准计算发病率和逆转率。确定了逆转的危险因素，并使用1980年WHO标准和1997年ADA标准确定了使用多元逻辑回归的最佳拟合模型。
采用1997年ADA标准，墨西哥裔美国男性和女性2型糖尿病的年龄调整发病率分别为10.8%和12.2%。对于非西班牙裔白人男性和女性，年龄调整发病率分别为5.5%和5.1%。使用1980年WHO标准记录了相似的年龄调整发病率。采用1980年WHO标准，2型糖尿病患者的逆转率为11.5%，采用1997年ADA标准为12.5%。这些比率没有显著差异。确定了许多逆转的危险因素。在控制年龄、性别和种族后，最佳拟合模型包括基线2小时血糖水平、基线高密度脂蛋白胆固醇和既往糖尿病诊断。1980年WHO标准和1997年ADA标准的模型相同。
使用1980年WHO标准或1997年ADA标准，糖尿病患者的发病率或逆转率没有显著差异。此外，使用任何一组标准，逆转的危险因素都非常相似。在本研究中，ADA标准的修订对逆转没有显著影响。
